List the novel risk factors for CAD
1) markers of inflammation, ischemia, and thrombosis (elevated high sensitivity
C-reactive protein, troponin, fibrinogen) 2) adipokines (leptin, adiponectin) 3) CKD
4) air pollution and ionizing radiation 5) medications (NSAIDs) 6) coronary artery
calcification and carotid wall thickness and 7) microbiome 8) small dense LDL
particles and lipoprotein(a) 9) Hyperhomocysteinemia
List nonmodifiable risk factors for CAD
Advanced age, male gender or woman after menopause, and family history
(genetics, shared environmental exposure).
List modifiable risk factors for CAD
Dyslipidemia, hypertension, cigarette smoking, diabetes and insulin resistance,
obesity and sedentary lifestyle, and an atherogenic diet.
How does dyslipidemia contribute to CAD?
High levels of LDL in the bloodstream leads to LDL oxidation, migration into the
vessel wall, and phagocytosis by macrophages, all key steps in the pathogenesis
of atherosclerosis.
Atherosclerosis
A chronic inflammatory condition that results in damage to the arteries.
Thickening and hardening of the vessels are caused by the accumulation of
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lipid-laden macrophages (foam cells) within the arterial walls, leading to the
formation of a plaque.
Optimal lipid panal results
Total cholesterol (< 200), LDL (< 100), triglycerides (< 150) What is the response-to-injury hypothesis in the development of atherosclerotic lesions? The earliest event in atherogenesis is injury to the endothelium, which could be triggered by hypertension, circulation of ROS (smoking, pollutants), dyslipidemia, and elevated A1C. When foam cells accumulate in a significant amount within the arterial wall, they form _ . What is then released? a lesion called a fatty streak; inflammatory cytokines, damaging enzymes, and growth factors. Growth factors released released in atherogenesis stimulate _ , which
.
smooth muscle cell proliferation; produce collagen and migrate over the fatty
streak to form a fibrous plaque.
Plaques that have ruptured are called .
complicated plaques
Plaque rupture occurs because of the _ .
inflammatory activation of proteinases, apoptosis of cells within the plaque, and
bleeding within the lesion (plaque hemorrhage)